Following on from that, the limited extent of the reshuffle – with Education being the only really significant department seeing a change – is another depressing reminder that Britain is led by someone without the authority to stamp her will on a party which is crying out for firm direction, let alone on a fractious and divided country.

Thirdly, even if Theresa May had wanted to carry out a wider-ranging reshuffle, what could she possibly have done that would have made the slightest difference to the direction of her party, the ambitions of the government or the fortunes of the nation? Maybe tomorrow we will see some encouraging promotions to the junior ministerial ranks – one might hope that some solid backbenchers with a bit of vision and ideological gumption, people like Kwasi Kwarteng or Chris Philp, might finally be given some executive responsibility and a launchpad to bigger and better things.

But in terms of big-hitters whose appointment or shuffling might make an immediate impact on the overall tone of the government, there was precious little that could be done even if the prime minister had wanted to shake things up. The sickness within the Conservative Party is deep, pervading all the way up from the (dying) grassroots through the activists, prospective parliamentary candidates and much of the parliamentary party, and a reshuffle can only be as good as the cards you have to deal.

In terms of bright spots, one can summon a degree of enthusiasm for the fact that charismatic MP James Cleverly has been made Deputy Chair of the Conservative Party, but odds are that the centralising, micromanaging bureaucrats of CCHQ will chew him up and spit him out just as they did to Rob Halfon before him, nodding sagely while Cleverly reels off a litany of smart and worthwhile suggestions before ploughing on in exactly the same dismal direction as before, tacitly encouraged by Theresa May.

I do also reserve a spot of admiration for “beleaguered” Health Secretary Jeremy Hunt (which Health Secretary of either party has ever not been described as beleaguered, and at this point shouldn’t that really tell us more about the anachronistic National Health Service for which they are responsible than the personal acumen of any given incumbent?).

Being a Tory Health Secretary is surely the most lethal of poisoned chalices when it comes to future career prospects. The role guarantees that one will be pilloried by the Left as a heartless monster who cackles as nurses are forced to food banks and patients die on trolleys, regardless of one’s actual record.

For some reason either involving masochism or great nobility, Jeremy Hunt has borne this burden stoically for six years, and for him to plead with Theresa May to not only keep his current brief but also assume responsibility for social care is quietly impressive, and shows character. I personally think that the Tories are far too timid when it comes to healthcare, but if we must set our sights low and keep Our Blessed NHS in more or less its current form, we at least need to merge it with social care – and hopefully this is an indication that the government is looking to do so.

The main problem with the reshuffle though, aside from its timidity, is that it gives no real indication of a likely change in the soul of this ideologically lost Tory government. All of the great offices of state, the main levers through which a government might seek to remake the country in its image, remain in the same uninspiring hands. Meanwhile, a bunch of junior ministers play musical chairs with one another in a frenetic pantomine apparently designed to distract us from the fact that the prime minister remains far too politically weak to move any of the people who most need moving.

But even if Theresa May did have any residual authority to undertake a real reshuffle, what difference would it make? The reshuffles that truly matter in historical or strategic terms are ones where you think “ooh, that person is going to take Department Y in a totally different direction because they are a strong believer in X”. One thinks of Margaret Thatcher’s reshuffle in 1981, in which she sought to purge some of the Tory Wets, remaining holdovers from the days of opposition who were still wedded to the failed post-war consensus.

Yet few MPs serving in Theresa May’s Cabinet, especially the most senior ones, are known for having strong ideological feelings about anything at all. Indeed, many of them seem to cultivate a deliberate sense of vagueness, giving speeches stuffed with meaningless platitudes to disguise the fact that they are chickening out from taking a bold position on anything remotely controversial (cough, Amber Rudd, cough).

Believing in things and daring to stake a bold position is dangerous in this day and age – unless you are Jeremy Corbyn or retiring from electoral politics. Far better to be blandly inoffensive, to keep everybody on side and be ambiguous about your intentions if you want to get ahead – only too often this leads to the gradual atrophy of any real policy intentions at all. Spend long enough trying to be all things to all people and soon enough you’ll forget what, if anything, you went into politics to do in the first place.

This uninspired, unambitious, managerial technocracy was the algae-asphyxiated pond in which Theresa May went to fish for new talent, and her near total lack of authority within her own party was the dismal climate in which she set off with her rod and tackle. Unsurprising, then, that she came back with little more than a few old boots to show for her efforts.

And so to abandon the fishing metaphor for another, we have ended up with a reshuffle that most closely resembles a particularly dissatisfying game of Scrabble (or Words with Friends, for the smartphone-owning crowd). One swaps out a number of pesky and useless letter tiles in the hope of getting something better in exchange, but ends up with virtually the same tiles back again, only arranged in a slightly different sequence. All that effort and a missed turn, and still you are unable to spell anything meaningful or score more than a handful of points, be it on the Scrabble board or the statute books.

So far as I can tell, virtually nothing has changed. Good luck and God speed to James Cleverly as he goes off to bash heads together (or more likely have his own caved in) at CCHQ, and may angels minister to Jeremy Hunt as he continues his lonely mission to serve as Chief Cartoon Villain to every leftist in the land. But besides that, who seriously expects a shockingly new bold policy to emerge from this cohort?

I hope I’m wrong. But more than ever I think it is going to take external events – potentially very disruptive and unwelcome ones – to shock any kind of life back into the moribund Conservative Party, the kind of political shock therapy which also tends to land the patient back in Opposition for a time.

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Stephen Hawking vs Jeremy Hunt, a beloved national treasure going up against somebody who actually knows a thing or two about healthcare systems – in NHS-worshipping Britain, this could only end one way

If your car breaks down in the middle of the desert, who would you rather have come to your aid – the world’s most famous and accomplished concert pianist, or a fully equipped mechanic with a bit of a bad reputation?

Unless you particularly want to die of dehydration amid the sand dunes you pick the dodgy mechanic every time. At least he has some experience with the subject matter at hand, after all. And would you listen to angry protestations from other people who said that the concert pianist was equally entitled to tinker with your car, just because he has been driven around in many cars throughout his career? Of course not. Making use of the functions of an automobile is not the same as understanding how a vehicle works or being able to diagnose technical faults with the engine.

And yet as soon as the national conversation turns toward Our Blessed NHS, this kind of common sense goes out the window. So desperate are many British people to receive confirmation bias-affirming propaganda about “Our NHS” that when theoretical physicist Stephen Hawking got into a debate with Health Secretary Jeremy Hunt on the subject of healthcare, people essentially chose the concert pianist over the mechanic. Proudly and unequivocally.

This is the mental poison spread by the Cult of the NHS. It warps thinking, is impervious to reason and transforms what should be a measured, rational and unemotional debate about how best to provide healthcare services to a country of 70 million people into a frenzied orgy of emotionalism and unconditional praise for government bureaucracy, combined with a seething intolerance of anybody who dares to question the status quo.

Most unbecoming for a scientist, Stephen Hawking leaned heavily on emotional rather than empirical arguments to make his case, writing in the Guardian:

Like many people, I have personal experience of the NHS. In my case, medical care, personal life and scientific life are all intertwined. I have received a large amount of high-quality NHS treatment and would not be here today if it were not for the service.

The care I have received since being diagnosed with motor neurone disease as a student in 1962 has enabled me to live my life as I want, and to contribute to major advances in our understanding of the universe. In July I celebrated my 75th birthday with an international science conference in Cambridge. I still have a full-time job as director of research at the Centre for Theoretical Cosmology and, with two colleagues, am soon to publish another scientific paper on quantum black holes.

Whereas in France, Germany, Australia, Canada or Japan he would have been left to die in the street? This is misleading, emotionally manipulative balderdash of the first order. Newsflash, Stephen Hawking – the NHS did not save your life. Doctors and nurses and technicians and administrators did. And all of these professions can be found outside of our own creaking nationalised healthcare system.

Universal healthcare and treatment free at the point of use are not innovations unique to the United Kingdom. Other countries manage to do it too, using a variety of different delivery models – many of which achieve better healthcare outcomes (ultimately the only thing that matters to patients) than Our Blessed NHS.

And Stephen Hawking knows this full well. Yet he is happy to take advantage of the British public’s sentimentality for the NHS and lack of awareness of healthcare in other countries to create a false impression that motor neurone disease patients such as himself – indeed, people suffering from any disease or injury – are somehow left to die on the street in other countries, and that it is only in socialist Britain that people enjoy modern healthcare. This is the kind of dishonesty and low skulduggery that belongs in the field of politics, not science. Hawking should be ashamed of himself.

But he isn’t done yet. He continues:

Last year my personal experience of the NHS and my scientific life came together when I co-signed a letter calling for healthcare policy to be based on peer-reviewed research and proper evidence. The specific issue addressed in the letter was the “weekend effect”. Jeremy Hunt, the health secretary, had claimed that thousands of patients died unnecessarily because of poor hospital care at the weekend, and used this to argue that we needed to implement a seven-day NHS. I had mixed feelings about the issue. Having spent a lot of time in hospital, I would like there to be more services available at weekends. Also, it seems possible that some patients spend more time in hospital than is necessary because certain diagnostic tests can only be done on weekdays.

However, as we showed in the letter, Hunt had cherry-picked research to justify his argument. For a scientist, cherry-picking evidence is unacceptable. When public figures abuse scientific argument, citing some studies but suppressing others to justify policies they want to implement for other reasons, it debases scientific culture. One consequence of this sort of behaviour is that it leads ordinary people to not trust science at a time when scientific research and progress are more important than ever.

Yes, we wouldn’t want to cherry pick evidence now, would we Stephen? Like resolutely pretending that the only alternative to the NHS is “a US-style insurance system”, conveniently ignoring the wealth of other examples out there?

But even more asinine than this is Hawking’s assertion that healthcare policy should be based on “peer-reviewed research and proper evidence”. This is all well and good as far as it goes, but we are talking about designing complex human organisations here, not conducting a controlled physics experiment.

The only peer-reviewed research and evidence that can possibly be brought to bear on the question of how to design an optimal healthcare system for a medium-sized advanced economy will come from the social sciences, which are inexact and often unquantifiable by their very nature. What’s more, in academia the social sciences are populated almost exclusively by leftists and are effectively locked into a self-perpetuating purity spiral. When there is no diversity of perspective or political thought in the field, how can one have the slightest confidence in the outcome of the resulting studies?

Do you really think that scientists check their political opinions at the door of the library or laboratory? If so, where were all the economists during the EU referendum declaring in TV interviews that Brexit might be bad for the economy but still worthwhile overall? They were nonexistent. Why? Because they all started from a place of liking the European Union and wanting Britain to remain a member. Facts and evidence which contradicted this desired outcome were determinedly pushed aside, again and again.

The other issue I have with Professor Hawking’s comments is that they essentially capture the nauseating emotional connection that Brits have with healthcare provision. It is odd because healthcare needs are, by their very nature, private and oughtn’t represent bargaining chips for politicians at election time. ‘Groupthink’ surrounding the NHS is rife and poisonous. I particularly loathe the term ‘our NHS’. In using it we promote unhealthy tribalism, which blockades against meaningful debate about how we improve a stagnant system of healthcare. Diluting this poisonous emotional attachment is perhaps the first step to achieving a market-based system, similar to those seen all around the continent.

Notice also the reliance upon using the American healthcare system as some kind of stick with which to beat free marketeers in Britain. It is as if there are only two structures globally, and we must protect one from becoming the other. Professor Hawking, a clever man, knows full well that by instigating comparison with the United States he can more aptly generate support for the maintenance of the NHS. Which I believe, given changes to demographics, life-expectancy and population-induced strains, is bad for our healthcare outlook.

Increasingly, academics believe that, almost by right, they are entitled to transfer their authority in a particular field to other fields, often for the sake of making noise and boosting their own public profile. This became especially apparent during Britain’s referendum on European Union membership. Of course, I am not saying that academics should not have the right to speak and be heard. Nobody values the importance of free speech more than I do. The issue is that by association alone they are afforded disproportionate exposure and their words a special (and often unwarranted) significance. This is damaging to debate as it promotes laziness and useless conventional wisdom.

And besides, Stephen Hawking doesn’t really want to design an optimal healthcare system. No, he is attached to the present system for emotional reasons, and is busy corralling facts and figures which confirm his own biases and preferences. A rational scientist would start with a blank sheet of paper, not a crayon drawing of the NHS logo with girlish hearts scribbled all around it, à la Hawking.

Yet Hawking preposterously claims to be a dispassionate observer in all this:

A physicist like me analyses a system in terms of levels of approximation. To a first approximation, one can see the situation facing healthcare in this country in terms of forces with different interests.

Quite. So let’s talk about the NHS Industrial Complex, that byzantine and interconnected web of special interests from pharma companies to suppliers to logistics providers to medical schools to clinical staff on the taxpayer dollar, to the army of administrators and bureaucrats required to run what is – astonishingly – the fifth largest employer on the face of the Earth. All of these actors have a vested interest in the current system perpetuating itself – it’s how they get their pay cheques and make their profits. Disruption to steady-state operations is therefore unwelcome and to be resisted at all costs, even if there are potential windfalls for patients.

But these are not the malevolent forces that Stephen Hawking wishes to discuss. He wants to go on a generic leftist rant about the “multinational corporations, driven by their profit motive” – forgetting that the profit motive he so despises helped to spur the development of many drugs and healthcare technologies which save lives every day. He also takes the economically illiterate view that there is a fixed amount of money in the economy and healthcare system, and that shareholder profit necessarily means less funding available on the front line. This is nonsense, as any sixth-form economics student could have explained.

Hawking ends his cri de coeur with this rousing message:

If that all sounds political, that is because the NHS has always been political. It was set up in the face of political opposition. It is Britain’s finest public service and a cornerstone of our society, something that binds us together. People value the NHS, and are proud that we treat everyone equally when they are sick. The NHS brings out the best in us. We cannot lose it.

Isn’t it funny that if you want to make an establishment leftist sound like a frothing-at-the-mouth Ukipper all you have to do is whisper the letters “NHS”, at which point they will immediately start ranting about British culture and values, the importance of our unique island history and our unquestioned superiority over every other country.

And yet we see smug, superior headlines from the likes of the Independent, sardonically declaring “It’s brave of Hawking to take on an intellect like Hunt“, as though Stephen Hawking’s brilliance when it comes to physics somehow automatically translates to the complex political and organisational considerations involved in healthcare reform. This is basic, superficial thinking of the first order – and yet nearly every newspaper clapped along like trained seals, without stopping to think whether Hawking really has any credentials to be pontificating on the future of the NHS. He doesn’t.

Stephen Hawking is little more than an NHS Ukipper, with no more right to meddle in British healthcare reform than your garden variety Ukipper should be allowed to go up against Michel Barnier in the Brexit negotiations. But his ignorance and emotional manipulation are given cover by a bovine public raised to worship the NHS unquestioningly, and by a sycophantic media who prefer to make smartass headlines about Jeremy Hunt’s intellectual deficit rather than stopping to question who makes the better argument.

And as it happens, both men are wrong. Stephen Hawking is busy trying to reanimate the mortal remains of Aneurin Bevan, while Jeremy Hunt is tinkering around the edges of a failing system which needs redesigning from the ground up.

This is what passes for a debate about healthcare reform in this country, and the cost of all the virtue-signalling, NHS-worship and half-hearted reforms can be counted in human lives.

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This walk out, the first all-out strike since the NHS’s creation, isn’t over some issue of high principle. It’s about money. The main sticking point in their negotiations with the government is that Saturday shouldn’t be treated as a normal working day.

The BMA’s suggestion at the weekend that it was prepared to call off the walk out if the government didn’t impose the new contract, but instead pilot it for a while, suggests that even the doctors themselves fear they’ll lose public sympathy by going ahead with this strike.

Yes. The fact that the final sticking point in negotiations is around money reveals all of the previous lofty, high-minded concerns about public safety and “tired doctors making mistakes” to be the cynical campaign rhetoric that it is.

Forsyth hammers home the point on pay:

Under the government’s offer, those junior doctors who are on duty one Saturday in four will receive a premium pay rate of 30 per cent. This means they are, on average, getting paid more for working on Saturdays than nurses, midwives and paramedics. The proposed deal is also more generous than what firefighters and police officers get for doing their job on a Saturday. This is hardly grounds for a walkout that will inevitably put lives at risk.

Junior doctors are right that they are paid less than doctors in some other countries. But this is, in large part, because the state has heavily subsidised their education. By the time a doctor has finished their foundation training, the state has already spent a quarter of a million pounds on them.

Until doctors are prepared to pick up more of this tab themselves, they shouldn’t complain that some of those working in other health systems are paid more than them. Indeed, it would be sensible of the state to actually require medical students to commit to working in the NHS for a certain number of years before funding their training—something that it doesn’t currently do. Junior doctors should also remember that if they stay in medicine and become consultants, they will find themselves in the top two percent of earners in this country.

This blog is no fan of the current Conservative government and no great proponent of the latest NHS reforms. But for the sake of decency, this strike needs to be broken. And then we need to have a long, hard national conversation about why an advanced democracy like Britain is facing a national strike of any kind in the year 2016.

Hint: if we did not still have a monolithic nationalised health service – the fifth largest employer on the planet serving the 22nd largest country by population – we could never be in the ludicrous position of suffering a strike of all the junior doctors in the land. Doctors would not all share the same employer, patients would not all rely on the same medical service and we would all be spared this drama.

Something to mull over as the accusations and counter-accusations fly.

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How to respond to a national walkout by government employees who perform a critical job for a large organisation, and who cynically advance their demands for more money under the false banner of concern for public safety?

Ronald Reagan offers us one blueprint, from back in that dim and distant time when both Britain and America were blessed with leaders who (for their various faults and blind spots) were not afraid to lead, and to take bold and decisive action when necessary.

This is the speech Reagan gave in August 1981 when PATCO, the American air traffic controllers union, called an illegal strike (federal workers being prohibited from striking under the Taft-Hartley Act) demanding, among other things, a 32-hour work week:

This morning at 7 AM the union representing those who man America’s air traffic control facilities called a strike. This was the culmination of 7 months of negotiations between the Federal Aviation Administration and the union. At one point in these negotiations agreement was reached and signed by both sides, granting a $40 million increase in salaries and benefits. This is twice what other government employees can expect. It was granted in recognition of the difficulties inherent in the work these people perform. Now, however, the union demands are 17 times what had been agreed to – $681 million. This would impose a tax burden on their fellow citizens which is unacceptable.

I would like to thank the supervisors and controllers who are on the job today, helping to get the nation’s air system operating safely. In the New York area, for example, four supervisors were scheduled to report for work, and 17 additionally volunteered. At National Airport a traffic controller told a newsperson he had resigned from the union and reported to work because, “How can I ask my kids to obey the law if I don’t?” This is a great tribute to America.

Let me make one thing plain. I respect the right of workers in the private sector to strike. Indeed, as president of my own union, I led the first strike ever called by that union. I guess I’m maybe the first one to ever hold this office who is a lifetime member of an AFL – CIO union. But we cannot compare labor-management relations in the private sector with government. Government cannot close down the assembly line. It has to provide without interruption the protective services which are government’s reason for being.

It was in recognition of this that the Congress passed a law forbidding strikes by government employees against the public safety. Let me read the solemn oath taken by each of these employees, a sworn affidavit, when they accepted their jobs: “I am not participating in any strike against the Government of the United States or any agency thereof, and I will not so participate while an employee of the Government of the United States or any agency thereof.”

It is for this reason that I must tell those who fail to report for duty this morning they are in violation of the law, and if they do not report for work within 48 hours, they have forfeited their jobs and will be terminated.

Obviously such a feat could not be repeated by the British government in its dealings with striking NHS staff – though the case for banning strikes by national public sector workers becomes more compelling by the day.

This blog firmly believes that the NHS model is broken and than a system conceived in the 1940s is barely adequate to the demands of the 2010s, and will be hopelessly inadequate to the demands of the 2040s. If we are to persist with a public option, then there is no reason why healthcare should continue to be provided by a monolithic government organisation, the fifth largest employer in the entire world (with all the baggage, internal politics and resistance to change which that stunning fact implies).

There is no good reason why we cannot look closely at the healthcare systems of countries such as France, Germany, Japan or Canada and redesign our system accordingly – if only we could rediscover our sense of national ambition and shed our increasingly unwarranted pride in the NHS. We could even still call the new healthcare system “the NHS” if our cult-like attachment to the brand really runs so deep.

The time is long overdue for Britain to have that national conversation, endlessly kicked down the road by politicians terrified of upsetting nervous voters and governments which have proved constitutionally incapable of daring mighty things. But first we need to overcome this peculiar, anachronistic industrial dispute – one which belongs more comfortably in 1976 than 2016 – and end the junior doctors’ strike, by imposing the current contract offered if necessary.

And in that effort, let the spirit of Ronald Reagan guide Jeremy Hunt.

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By reflexively worshipping the NHS, vilifying people who don’t and rewarding politicians who tell us only what we want to hear, the junior doctors’ strike – and everything else wrong with the health service – is our fault, and ours alone

Is it heartless Jeremy Hunt, that doctor-hating, treatment-denying Conservative villain at the Department of Health? Is it the Evil Tories in general, with their single-minded obsession (mysteriously never realised despite all their accumulated years in power) with privatising and destroying Our Precious NHS? And if not them, who could it be? The capitalists? The bankers? Katie Hopkins?

Surely anyone and everyone is to blame, apart from ourselves.We love Our NHS. We are good people who believe that healthcare free at the point of use is one of the fundamental rights of citizenship. We stick up for the NHS at every turn, demanding that politicians pay obsequious lip service to the organisation every time they run for office. We’ll happily slap the NHS logo on our Facebook profile picture, paint it on our faces, wear it on a badge, lapel pin or t-shirt. You name it, we’ll do it to virtue-signal the love we have for Our NHS.

And that, right there, is the problem. Not Jeremy Hunt, not the Evil Tories, not Katie Hopkins. Us.

We don’t want elected officials who take a hard, uncompromising look at changes in medical treatments, life expectancies, the public finances and best practice from overseas to continually assess whether the NHS – that uniquely British solution to healthcare coverage – is still fit for purpose in the twenty-first century, and what changes may be beneficial or necessary.

We don’t want elected officials who tell us that difficult decisions might have to be made – that providing the latest treatments to an ageing, fattening population will cost all of us more in taxes, require radical overhaul of the NHS model, or both. We want our politicians to find the money to provide a world-class health service without disrupting other areas of public spending, or the fatness of our own wallets.

And we certainly don’t want elected officials who do anything to upset the NHS-Industrial Complex – that vast network of people, organisations and vested interests who are first to squeal and protest (always in the name of “public safety”) when their own livelihoods or ways of working are threatened. Like children listening to a trusted school teacher, we innocently take the words of such people as gospel.

Of course, this situation is quite unsustainable. And when any one element of this vast human bureaucracy reaches breaking point – whether that is manifested in industrial action, hospital death scandals or longer waiting lists – we will look for anyone to blame and attack for the fact that these problems have gone unaddressed. Anyone other than ourselves.

[..] there is a more serious way in which the public is to blame for the sickness of the health service. The electorate that notionally adores “our NHS” and propels a saccharine song by health workers to the top of the Christmas charts shows remarkably little willingness to pay more in tax towards what remains a relatively cheap system. Without extra money and facing ever wider and wrinklier patients, the NHS must tighten its belt by £30 billion ($43 billion), or about one-fifth, by 2020. It is in this context that Mr Hunt is trying to expand services to evenings and weekends. Pity the well meaning health secretary, pity the hardworking doctors—and blame the sentimental but hypocritical British public.

The famous maxim says that people get the politicians and leaders that they deserve. Well, the same can be said for healthcare, too. We refuse to look difficult truths in the eye, preferring to ignore them in the risible hope that a healthcare system built in 1948 can still be fit for purpose in 2016, if only we pump a bit more money into it. And a bit more. And a bit more again.

We deserve the NHS we currently have, with its air of permanent crisis, in all its faded glory. It is the sum total of all our misplaced pride, boastfulness, smugness, ignorance, fear of change, intellectual laziness and lack of vision.

We have become the kind of intellectually dull society that will happily produce a cheesy Christmas hymn to the NHS and then propel it to Number 1 in the charts, but prefers to sit and vegetate in front of Britain’s Strictly Come Bake-off On Ice rather than question whether the organisation we were just singing about is fundamentally fit for purpose.

On this rare occasion, the Economist’s editorial line is quite correct. When it comes to the failings and shortcomings of the NHS, the government, the health secretary of the day and individual NHS staff are comparatively blameless.

It is we, the British people, who are most at fault for singing worshipful hymns of praise to a healthcare system we will neither properly fund, nor meaningfully reform.

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